摘要
目的探讨采用指掌侧固有动脉背侧支岛状皮瓣移植修复指体软组织缺损的手术方法及临床疗效。方法2013年3月至2021年5月,对22例指体软组织缺损采用指掌侧固有动脉背侧支岛状皮瓣移植修复。其中拇指9例,示指5例,中、环指各3例,小指2例;修复指端8例,指腹7例,指背及甲床7例。软组织缺损范围0.8 cm×0.5 cm~1.5 cm×0.8 cm,皮瓣切取面积1.0 cm×0.7 cm~1.8 cm×1.0 cm。供区6例直接拉拢缝合,其余予以中厚皮片覆盖,加压包扎。术后通过门诊、电话或微信随访其临床疗效。结果术后1例因缝合过紧致皮瓣肿胀、青紫,给予间断拆线后解除;2例皮瓣术后出现张力性水疱,1周后消退;1例皮瓣远端坏死,经换药后愈合。其余皮瓣均顺利成活,切口及供区植皮均I期愈合。随访6~18个月,平均10个月。末次随访:皮瓣外形、质地均良好,恢复保护性感觉,患指屈、伸功能也恢复正常,TPD为7~11 mm。除未能重建指体的特殊结构,如指甲、指腹螺纹及精细的感觉外,重建了指体原有的基本外形及功能。依中华手外科学会上肢部分功能评定试用标准,结果优11例,良9例,中2例,优良率91%;供区无功能影响。结论采用指掌侧固有动脉背侧支岛状皮瓣移植修复指体软组织缺损伤,操作简单、成功率高、疗效满意,而且不损伤指体主干血管,值得推广。
Objective To investigate the surgical technique and clinical effect of the island flap of dorsal branch of proper palmar digital artery in repair of the soft tissue defect of digits.Methods From March 2013 to March 2021,22 cases of digit soft tissue defects were repaired with dorsal branch of proper palmar digital artery island flap.The digit defects involved:9 thumbs,5 index fingers,3 middle fingers,3 ring fingers and 2 little fingers.The repair of defects covered 8 digit-tips,7 pulps and 7 dorsal and nail beds.The defected area of soft tissue was 0.8 cm×0.5 cm-1.5 cm×8.0 cm,and the size of flap was 1.0 cm×0.7 cm-1.8 cm×1.0 cm.The donor site in 6 cases was closed directly.The other 16 cases were covered with medium thickness skin graft and pressurised bandaging.The follow-up reviews were carried out via the outpatient clinic visit,telephone or WeChat interview.Results After operation,1 flap had cyanosis due to a tight suture and it was relieved after the removal of intermittent suture;Tension blisters appeared in 2 cases and disappeared after 1 week;One case had necrosis at distal flap and healed after dressing change.Other flaps survived successfully and the incision and donor site healed in the first stage.All patients were entered to 6 to 18(mean 10)months of follow-up.At the final follow-up,the appearance and texture of the flaps were good and the protective sensation was restored.The flexion and extension function of the affected digit was normal with the TPD at 7-11 mm.The original shape and function of the digit body were basically reconstructed,except the failure in reconstruction of the special structure of digit body,such as nail,finger pulp thread and fine sensation.According to the Evaluation Standard of Upper Limb Function of Chinese Hand Surgery Society,11 cases were in excellent,9 in good and 2 in fair.The excellent and good rate was 91%.The function at donor sites was not affected.Conclusion Repair of digit soft tissue defect with dorsal branch of proper palmar digital artery island flap is easy to operate,and with a low risk,high success rate and satisfactory curative effect.
作者
刘刚义
张洁
李建梅
张锦涛
杨伟超
王春旭
李晓妮
王芳
马光兵
LIU Gangyi;ZHANG Jie;LI Jianmei;ZHANG Jintao;YANG Weichao;WANG Chunxu;LI Xiaoni;WANG Fang;MA Guangbing(Department of Hand Surgery,Baoji Third Hospital,Baoji,Shanxi Province 721000,China;Department of Hand Surgery,987 Hospital of PLA,Baoji,Shanxi Province 721004,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2022年第2期144-147,共4页
Chinese Journal of Microsurgery
关键词
岛状皮瓣
指掌侧固有动脉背侧支
修复
指损伤
显微外科技术
Island flap
Dorsal branch of proper palmar digital artery
Repair
Digit defect
Microsurgical technique
